Outcome measures in psoriatic arthritis: Where next?

Abstract

Objective: To provide an overview of commonly used outcome measure in psoriatic arthritis (PsA).Background: PsA is a heterogenous inflammatory arthritis, associated with psoriasis that affects between 0.1% and 2% of the population and approximately one in three patients with psoriasis. Psoriatic arthritis places a significant burden on patients' overall quality of life and is associated with a range of comorbidities. Although assessment of patients and monitoring of symptoms has greatly improved over the last 2 decades, capturing disease activity in this multisystem disease remains challenging. Previous efforts have traditionally focussed on assessment of individual disease domains, however recent evidence suggests that composite measurements, particularly those incorporating patient reported outcomes may not only help monitor disease activity more accurately, but also help in accurately validating therapy outcomes in PsA patients.Purpose: This review discusses currently used outcome measurements in PsA and also highlights the importance of emerging measurements such as biomarkers and their possible role in capturing treatment response. K E Y W O R D S outcomes measurements, PROM, psoriatic arthritis 1 | INTRODUCTION Psoriatic arthritis (PsA) is a heterogenous condition with musculoskeletal involvement, manifesting as a variety of symptoms including arthritis, dactylitis, enthesitis and axial involvement (Coates and Helliwell, 2017). In addition to musculoskeletal symptoms, patients with PsA have other symptoms such as nail disease, which affects between 63% and 83% of patients (Nieradko-Iwanicka, 2017). Along with the varied nature of symptoms, the repercussions on patients are equally as diverse. Patients with PsA have an increased risk of comorbidities such as cardiovascular disease, metabolic syndromes, depression, inflammatory bowel disease and anxiety. In order to measure the impact of PsA on patients, a range of outcomes measures have been developed to ascertain disease impact and help monitor response to treatment in both clinical trials and the realworld settings. Despite the development of a range of outcome measures for patients, agreement as to the exact measure that should be utilized remains a challenge. Recent recommendations from the TIght Control Of Psoriatic Arthritis (TICOPA) trial have highlighted the need and importance of regular assessment of disease activity by clinicians, as well as the critical role patients play in capturing their own concerns (Coates et al., 2015). To capture these outcome measurements, The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) PsA working group developed a This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Therapeutic Effects of Apremilast on Enthesitis and Dactylitis in Real Clinical Setting: An Italian Multicenter Study

“…For each patient, the following data were recorded: general characteristics (age, sex, body mass index (BMI), smoking habit, PsA and PsO onset, and date of diagnosis), PsA phenotype (enthesitic and dactylics subtype), apremilast-related information (date of the first and last treatment administration), other PsA treatment history (both csDMARDs and bDMARDs), PsA disease activity (number of tender/swollen joints, painful enthesis and fingers affected by dactylitis, C-reactive protein, pain Visual Analog Scale, and patient global assessment values), and the presence of comorbidities at baseline, 6 months (T1), and 12 months (T12). DAPSA, LEI, and Dactylitis were assessed as measures of disease activity [ 17 ]. Enthesitis was determined by the presence or absence of tenderness at the following sites of the LEI: lateral epicondyle (left and right), medial femoral condyle (left and right), and Achilles tendon insertion (left and right) [ 18 ].…”

“…The absence (score = 0) or presence (score = 1) at each of the six sites was evaluated and added to produce an LEI total score ranging from 0 to 6. Dactylitis is defined as “uniform swelling such that the soft tissues between the metacarpophalangeal and proximal interphalangeal, proximal and distal interphalangeal, and/or distal interphalangeal joint and digital tuft are diffusely swollen to the extent that the actual joint swelling could no longer be independently recognized” [ 3 , 17 ]. Dactylitis score was evaluated in patients with a dactylitis count > 0 at baseline, reflecting the presence (score = 1) or absence (score = 0) of dactylitis in each of the 20 digits (the possible dactylitis count ranges from 0 to 20) [ 19 , 20 ].…”